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H and N > Clinical diagnosis of head & neck conditions > Flashcards

Clinical diagnosis of head & neck conditions Flashcards

1
Q

Common presenting head &neck symptoms (7)

A 
Persistent sore throat
Dysphonia - hoarseness
Dysphagia- difficulty swallowing
Odynophagia- painful swallowing
Otalgia- earache
Mouth/throat ulcer 
Neck lump
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2
Q

Physical examination of head &neck includes what structures (7)

A 
Neck
Nose 
Ears
Oral cavity
Pharynx 
Larynx
Salivary glands
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3
Q

Investigation of throat

A

Laryngoscopy = endoscopy of larynx

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4
Q

Investigations for head & neck pathologies (8)

A

FNAC

CT/MRI/PET
USS
Plain XR
Contrast swallow

Endoscopy

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5
Q

1st line investigation for neck lump

A

FNAC

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6
Q

Questions to ask in PC about a neck lump (5)

A 
How long have they had it?
Has it changed size/got better worse?
Does it fluctuate (does it come and go)?
Any pain with the lump?
Any symptoms associated with lump/any other lumps?
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7
Q

Physical examination of the lump should consider what properties of the lump (6)

A 
Size
Shape
Soreness
Skin
Mobility - fixed or mobile
Soft/firm
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8
Q

Neck lump differentials (5)

A 
Branchial cyst
Lipoma
Thyroglossal cyst
Reactive lymph node
Tumour
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9
Q

Properties of a neck tumour (4)

A

Round, firm, fixed (immobile), non-tender

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10
Q

What does globus pharyngeus refer to + what is it associated with

A

A feeling of a lump in the throat

Acid reflux

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11
Q

3 salivary gland conditions

A

Pleomorphic adenoma
Parotitis
Salivary duct calculus (stones)

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12
Q

What is a pleomorphic adenoma

A

Tumour of the parotid gland

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13
Q

What are salivary duct calculi + what symptoms do they cause

A

Stones blocking salivary ducts - usually in submandibular duct

Pain and swelling of affected gland

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14
Q

Questions to ask a patient with hoarseness (9)

A 
How long have they had it?
Is it persistent or intermittent?
Is there any pain associated with the hoarseness?
Is there any cough associated?
Are there problems with swallowing?
Do they sing?
Do they have asthma?
Do they have acid reflux?
Do they smoke?
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15
Q

Causes of hoarseness (7)

A 
Nodules in vocal cord
Cysts in vocal cord
Vocal abuse 
Laryngitis
Infection
Smoking
Laryngeal cancer
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16
Q

Pathophysiology of hoarseness

A

Damage of recurrent laryngeal nerve (branch of CN X)

17
Q

Questions to ask a patient with dysphagia (4)

A

What do you find difficulty doing?
Is it persistent/intermittent?
Is there any pain?
Where is the dysphagia located? - usually upper/middle neck

18
Q

Causes of dysphagia (4)

A

Foreign body in oesophagus
Tumour
Stricture
Pharyngeal pouch

19
Q

Dysphagia investigations

A

UGIE

Barium swallow

20
Q

Head and neck cancers are predominately what type of tumour

A

Squamous carcinoma

21
Q

Head & neck cancer treatments (3)

A

Surgery - neck dissection + flap reconstruction

Palliative radiotherapy/chemotherapy

22
Q

What is stridor

A

High pitched noisy breathing caused by airway obstruction

23
Q

2 types of stridor + what area of the airway is usually obstructed to cause that type of stridor

A

Inspiratory stridor = laryngeal obstruction; usually above glottis

Expiratory stridor (wheeze) = tracheobronchial obstruction; usually lower trachea

24
Q

Difference between wheeze and stridor

A

Wheeze is only during expiration whereas stridor can be both

25
Q

Management of stridor

A 
ABC:
Secure airway - intubate or tracheostomy
Oxygen
Steroids (IV dexamethasone)
Nebulised adrenaline
26
Q

Tonsillitis pathogenic causes

A

Usually virus, less so bacteria

27
Q

Tonsillitis symptoms (3) + signs (4)

A

Sore throat
Dysphagia
Stiff neck

Red swollen tonsils
White patches on tonsils
Fever
Enlarged cervical lymph nodes

28
Q

Complication of tonsillitis (1)

A

Quinsy (peritonsillar abscess) - collection of pus behind tonsil

29
Q

Tonsillitis investigations (2)

A

Throat swab + culture

Streptococcal antigen test - to see if it’s bacterial tonsillitis

30
Q

Tonsillitis treatment (viral and bacterial) (3)

A

Viral - rest, fluids, treat fever
Bacterial - antibiotics
Tonsillectomy if tonsillitis recurs of if bacterial tonsillitis doesn’t respond to antibiotics

31
Q

Questions to ask in SH about a neck lump (4)

A

Smoking
Alcohol
Foreign travel
Recreational drugs

32
Q

Questions to ask in PMH about a neck lump (5)

A 
Recent URTI?
Previous or existing head & neck disease?
Immunosuppression?
Existing DM?
Existing or previous TB?
33
Q

Associated symptoms to ask about in a general systematic enquiry of a neck lump (5)

A 
Weight loss
Anorexia
Fever
Night sweats
Bone pain

H and N (14 decks)

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